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Nursing Skills - PowerPoint PPT Presentation

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Nursing Skills. Position, Turn, and Transfer patients Make a bed Administer personal care and apply restraints. Objectives. Must use correct body mechanics Alignment = Positioning body parts in relation to each other to maintain correct body posture

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Nursing skills




Position, Turn, and Transfer patients

Make a bed

Administer personal care and apply restraints


Positioning turning moving and transferring patients

Must use correct body mechanics

Alignment = Positioning body parts in relation to each other to maintain correct body posture

Correct alignment helps pt. feel comfortable; prevents fatigue, Decubitus ulcers and contractures

Positioning, Turning, Moving and Transferring Patients

Decubitus ulcer

  • Pressure sore or bed sore

  • Caused by pressure that interferes with circulation

  • Usually at bony prominences – coccyx, hips, knees, heels, and elbows

  • First sign is a pale or reddened area on the skin

Decubitus Ulcer

Decubitus ulcer cont

Vesicle or blister may for at the site

Cells die, skin breaks down and open sore (ulcer) develops


Decubitus Ulcer Cont.

Prevent decubitus ulcers by

Good skin care

Prompt cleaning of urine and feces from skin

Massage in circular motion around reddened area

Light dusting of powder to prevent friction

Frequent turning and positioning…q 2h

Linen dry and free from wrinkles

Use of pressure-relieving surfaces

Prevent Decubitus Ulcers by:



Contractures cont

Weakened body parts must be supported with pillows, bed cradles, footboards, rolled blankets or towels

Pt must be turned frequently

Contractures Cont.

Turning moving and transferring

  • Dangling cradles, footboards, rolled blankets or towels

    • Sitting on side of bed prior to standing

    • Allows patient time to adjust

    • If the patient c/o vertigo, weakness or diaphoresis – return pt. Immediately to supine position

  • Mechanical Lifts

    • Used to transfer weak or paralyzed patients

    • Be sure you have been instructed on proper use

    • Reassure patient during transfer

Turning, Moving, and Transferring

Turning moving and transferring cont

  • Transferring cradles, footboards, rolled blankets or towels

    • Be sure to protect patient and health care worker

    • Be sure you know how to operate the wheelchair/stretcher

    • FIRST Lock the wheels

Turning, Moving, andTransferring Cont.

When turning and transferring

Before moving patient, obtain proper authorization from immediate supervisor

Watch the patient closely – pulse rate, respirations and color

Observe for weakness, dizziness, increased perspiration or discomfort

If you note abnormal changes, return the patient to a safe and comfortable position and notify your supervisor

When turning and Transferring

Moving the pt up in bed

Lower the head of the bed immediate supervisor

Place the pillow against the bed frame to protect the pts. Head

If pt. has trouble breathing, raise the head of the bed

Ask the pt. to flex the knees and brace the feet on bed / pushing heels into the bed to assist

Moving the Pt. Up in Bed

Nursing skills

Place one arm under the pts. Head and shoulders immediate supervisor

If the patient is unable to help, get someone to assist you

Get a broad base of support and as close to the bed as possible

Arrange a signal – “On the count of three, push with your feet”

On the signal, shift your weight forward

Two people can use a draw sheet or lift sheet

Turning the pt

Lower the side rail nearest you – be sure the opposite side is up

If the pt. is lying in the center of the bed, place hands under the pts head and shoulders and slide the pt toward you

Place both hands under the hips and slide the hips toward you

Turning the Pt.

Turning the pt cont

Place both hands under the legs and slide the legs toward you

Cross the pts. arms across his/her chest

Move the leg closest to you over the other leg

Get close to the pt. and roll the pt. away from you

Explain what you are doing to the pt.

Place your hands under the head and shoulders, then the hips, drawing the pt. to the center of the bed

Turning the Pt. Cont.


  • Linen must be free of wrinkles as they could cause discomfort and lead to decubitus ulcers

  • Closed Bed

    • Made after the pt. is discharged and after terminal cleaning of unit

    • Purpose: keep bed clean until new pt. comes

  • Open Bed

    • Fanfold top sheets to welcome new pt. or for ambulatory pts.


Bedmaking cont

  • Occupied Bed discomfort and lead to decubitus ulcers

    • Bed made while pt. is in it

  • Bed with Cradle

    • Cradle is placed under top sheets to prevent linen from touching parts of the pts. Body. Used for pts. With burns, skin ulcer, blood clots, fractures, and other similar conditions

Bedmaking Cont.

Bedmaking tips

Observe correct body mechanics discomfort and lead to decubitus ulcers

Keep linen arranged in the order of use

Make one side of the bed completely, then on the other side

Roll dirty linens away from your body and place in hamper immediately

Bedmaking Tips

Nursing skills

Do not shake clean or dirty linen. discomfort and lead to decubitus ulcers

Place open end of the pillowcase away form the door

Wear gloves while handling dirty or contaminated linen

Oral hygiene

  • Benefits: discomfort and lead to decubitus ulcers

    • Provides comfort

    • Stimulates the appetite

    • Prevents disease and dental caries

    • Helps to prevent bad breath (halitosis)

    • Stimulates saliva production which contains digestive enzymes and promotes digestion

Oral Hygiene

Routine oral hygiene

Involves tooth brushing and flossing discomfort and lead to decubitus ulcers

Should be done at least three times a day

Provide necessary equipment such as toothbrush, toothpaste, dental floss, mouthwash, emesis basin, cup, and water

Assist the patient as needed

Routine Oral Hygiene

Denture care

  • Proved privacy for the pt. discomfort and lead to decubitus ulcers

  • Have pt. remove dentures if able

  • Place dentures in a denture cup to carry to sink

  • Use warm water to clean dentures…hold over emesis basin lined with paper towels to prevent them breaking if you drop them

  • Hold dentures securely. Let pt rinse mouth and brush gums

  • Store dentures in a denture cup labeled with the pts. Name

Denture Care

Special oral hygiene

  • Usually given to unconscious or semiconscious pts discomfort and lead to decubitus ulcers

  • Tell the pt. what you are doing

  • Turn pt to their side

  • Turn pts head toward you

  • Use a very small amt. of liquid

  • Clan all areas of mouth:

    • Teeth, Gums, Tongue, Roof of Mouth

  • Apply lubricant to tongue and lips

Special Oral Hygiene


  • Types of Baths discomfort and lead to decubitus ulcers

    • Complete Bed Bath (CBB)

      • Pt. is usually confined to bed and the health care worker must bathe all parts of the pts. body

    • Partial Bed Bath

      • Pt. washes some of the parts of their body and the health care worker washes the parts of the body the pt. cannot reach


Bathing cont

  • Tub Bath or Shower discomfort and lead to decubitus ulcers

    • Health care worker prepares the tub or shower area and assists pt. as needed

    • Cleans tub once bath is over and pt is back in their bed or chair

Bathing Cont.

Complete bed bath

  • Use standard precautions discomfort and lead to decubitus ulcers

  • Provide privacy, comfort, and safety

  • Fill basin 2/3 full with warm water at a temp. of 105-110 F

  • Form a mitten around your hand with the cloth to keep from hitting pt during bath

Complete Bed Bath

Cbb cont

  • Wash body parts in this order: discomfort and lead to decubitus ulcers

    • Face, ears, and neck -> axilla, arms, and hands (apply deodorant) -> chest, breast, and abdomen -> thighs, legs, and feet (change water) -> back, buttock, and back of perineum (give back rub) -> perineum area

    • Change water when it becomes too cool, dirty or soapy

CBB Cont.

Tub baths and showers

Usually require a physician’s order discomfort and lead to decubitus ulcers

Make sure tub or shower is clean

Put rubber mat in tub or shower

Full tubs half full with water at 105 F

Help pt. into the tub or shower (Use the shower chair for pt. who cannot stand)

Assist pt. as needed

Tub Baths and Showers

Tub baths and showers cont

Stay with pt. or make sure pt. can use the emergency call system

After bath or shower, cover pt. with a towel or bath blanket

Clean the tub or shower with a disinfectant after each use

Tub Baths and Showers Cont.

Measuring and recording intake and output

Measuring and Recording Intake and Output


  • Oral of fluid lost from the body.

    • Includes liquids taken by mouth

    • Also includes foods that are liquid at room temp. such as soup, jell-o, ice cream, pudding, and Popsicle’s

    • Tube feeding is usually recorded under oral intake

    • Fluids are measured in metric units – cc/ml


Intake cont

  • 1 Cubic Centimeters (cc) = 1 Millimeter (ml) of fluid lost from the body.

  • Memorize these equivalents

    • 1 ml or cc =15gtts (drops)

    • 5ml or cc = 1 tsp (teaspoon)

    • 15 ml or cc = 1 tbsp (tablespoon)

    • 30 ml or cc = 1 (oz) ounce

    • 240 ml or cc = 1 cup (8 oz)

    • 500 ml or cc = 1 pint (16 oz)

    • 1000 ml or cc = 1 quart (32 oz)

Intake Cont.

Measuring intake

  • Fred is on I & O. When you go into his room after lunch, you examine his lunch tray and find he consumed the following:

    1 hamburger, ½ bowl of chicken broth (1 soup bowl=200cc), 4 soda crackers, 1 cup of tea, ¾ carton of milk (1carton=8 oz), ½ bowl of jello (1 small bowl=120cc)

    What was Fred’s fluid intake?

Measuring Intake


Measuring output

  • Output = all fluids eliminated by the pt. examine his lunch tray and find he consumed the following:

  • BM

    • Liquids BMs are measured and recorded

    • Solid or formed BM is usually noted under feces or the remarks column

  • Emesis

    • Measure anything that is vomited

    • Also not color, type, and other facts in the remarks column

Measuring Output

Measure output cont

  • Urine examine his lunch tray and find he consumed the following:

    • Measure all urine voided or drained via a catheter

    • Men can collect their urine in a urinal and women can collect their urine in a bedpan or a special urine collector that can be placed under the seat of the toilet

  • Irrigation

    • Measure any drainage from nasogastric tubes, hemo-vacs, chest tubes or other drainage tubes

    • These measurements are usually done by the nurse

Measure Output Cont.

Measuring output1

Measuring Output


Feeding the pt

  • Prior to meal: the following:

    • Provide privacy

    • Help pt. use the bedpan or urinal if needed

    • Provide oral hygiene if desired

    • Remove emesis basins or bedpans for sight

    • Position pt. in a sitting position if allowed

    • Wash pts. hands and face

Feeding the Pt.

Feeding cont

Put over bed table in position the following:

Check to make sure the pt. is not NPO

Make sure the diet is correct for the pt.

Place a towel or napkin under pts. chin

Open packages and cartons; season and cut foods if necessary

Feeding Cont.

Steps for feeding pt

Test temperature of hot foods by placing small amount on wrist

Feed pt. slowly and allow them time to chew

Use separate straw for each liquid

Hold utensil at a 90 degree angle to the pt. mouth

Give small bites

Steps for feeding pt.

Steps for feeding pts cont

Alternate the foods and liquids wrist

Allow pt. to help as much as they are able to

Offer choices to the pt.

Wipe the pts. mouth as necessary

Encourage pt. to each as much as possible

Steps for Feeding Pts. Cont.

After the meal

Allow pt. to wash their face and hands wrist

Provide oral hygiene

Position pt. in correct body alignment

Clean area

Note how much food was eaten

Calculate I & O if this is ordered for pt.

After the Meal

Bed pans and urinals

  • Urinate, micturate, or void wrist– terms for emptying of the bladder, which stores urine

    • Urinals are used by male pts. when they need to micturate

    • A bedpan is used by females when they need to micturate

  • Defecate – having a bowel movement

    • Both men and women must use a bedpan when they need to defecate

Bed Pans and Urinals

Bedpans and urinals cont

  • Two main types of bedpans wrist

    • Fracture or orthopedic bedpan

    • Standard bedpan

  • Many patients are sensitive about using the bedpan. Always provide privacy and make them as comfortable as possible.

Bedpans and Urinals Cont.

Assisting with a bedpan

  • Use standard precautions and wear gloves wrist

  • Provide privacy for the pt

  • Warm bedpan by running warm water over it

  • There are two positions to place the pan under the pt.

    • Pt. flexes knees and puts weight on heels. They then lift their hips up

    • Pt. is turned to one side and the pan is placed against the buttock and the pt is rolled back on the pan

Assisting with a Bedpan

Assisting with a bedpan cont

The pts. buttocks should rest on the rounded portion of the pan

Place call bell and tissue within the pts. reach

Raise siderail before leaving the pt.

Assisting with a Bedpan cont.

All done

  • Answer call bell immediately pan

  • Use the same positions to get pt. off the pan, but hold pan firmly

  • Cover the bedpan and place on nearby chair or table

  • Make sure perineum is clean and dry

  • Assist pt. in washing hands

  • Clean bedpan and note any abnormalities of urine or BM

All Done 

Assisting with urinal

Use standard precautions and wear gloves pan

Provide privacy for pt.

Assist with placement of the urinal if needed

Leave the call bell and toilet tissues near the patient

Answer the pts. call bell immediately

Assisting with Urinal

All finished

Avoid exposing the pt. pan

Have pt. hand you the urinal if they are able

Close the lid or cover the top of urinal

Assist pt. with washing hands

Assist pt. with washing perineum if needed

Measure contents of pts. I & O

Empty urinal and clean

Report abnormalities related to urine

All finished 



Restraints cont

  • Types of restraints others

    • Straps or safety belts

    • Limb restraints

    • Leather Cuffs or locks

    • Restraint jackets

      Restraint applied unnecessarily=false imprisonment

Restraints Cont.

When using restraints

Use only when other alternatives fail others

Allow pt. to move as much as possible

Always tell pt. why they are being restrained

Reassure pt. frequently

Check circulation below limb restraints every 15 minutes

All restraints must be removed every 2 hours, condition of skin documented and skin care given

When using restraints

Complications from restraints

Physical and mental frustration others

Impaired circulation

Decubitus ulcers

Loss of muscle tone

Joint stiffness

Respiratory or breathing problems

Complications from Restraints